The Divide Over Involuntary Mental Health Treatment

Involuntary commitment to a hospital for mental illness can be a lengthy and complex process. A California law makes mandatory outpatient treatment an option.

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Originally published on May 29, 2014 1:19 pm

The attacks near the University of California, Santa Barbara, are renewing focus on programs aimed at requiring treatment for people who are mentally ill as a way to prevent mass shootings and other violence.

In California, a 2002 law allows authorities to require outpatient mental health care for people who have been refusing it. Proponents argue that this kind of intervention could prevent violent acts.

But counties within the state have been slow to adopt the legislation, and mental health professionals are divided over its effects.

Do Family And Friends Know Best?

The story behind Laura's Law begins in 2001. In rural Nevada County, near Lake Tahoe, 19-year-old Laura Wilcox was shot and killed by a 41-year-old man with a history of mental illness. He had walked into the county's behavioral health center and opened fire.

Tom Anderson was the county's chief public defender at the time and represented the gunman in court. He recalls that the man's family had tried to alert mental health officials numerous times before the shooting.

"[Officials] were declaiming privacy issues and stuff and wouldn't communicate with the family," Anderson says. "He ... started amassing guns and setting up booby traps around his house, and he had this psychosis of he was going to be attacked any minute."

Now Nevada County's presiding judge, Anderson is also a vocal advocate for Laura's Law, which was passed by the state Legislature in 2002. The law allows counties to compel outpatient treatment for people whose family or friends are concerned about their mental state. It's seen as an intermediate step before someone is forced into inpatient psychiatric care.

Anderson says this tool could be one way to prevent future violent incidents, including mass shootings. And, he says, the patients often respond positively.

"The beauty of the program — the wonderment of it to me — is that roughly about 60 percent of the people that they do outreach to, where they go out to intervene after a person has been referred, voluntarily accept services at that time," he says.

A Question Of Rights

So far, only two California counties — Nevada County and Orange County — have gone forward with implementing Laura's Law. And the state hasn't allocated any funding to it.

The legislation is controversial. There are concerns that involuntary treatment could make mentally ill people vulnerable to civil rights abuses.

"You do have to be conscious that even though these people are mentally ill, they do have rights," says Steve Pitman, board president of the Orange County chapter of the National Alliance on Mental Illness.

Pitman, whose brother dealt with mental illness for 50 years, says family members need more power to intervene and force treatment. He says they're the ones who often know what's really going on, while police or a county mental health official may have just a few minutes to drop by for a welfare check.

"The problem in so many of these cases is that when they're interviewed to see if they meet those kind of threshold requirements, they don't give off any signals of being a danger to themselves or others," Pitman says. "Somebody who's experienced in these kinds of things knows all the right answers to give. They don't want to go to the hospital, so they say all the right things."

That scenario echoes Elliot Rodger's alleged behavior prior to the Santa Barbara incident, in which he allegedly killed six people, then himself.

But Pitman and others are cautious about linking policy changes like Laura's Lawtoo closely to recent mass shootings. For one thing, they say, intervention cases that fall under Laura's Law may take weeks, if not months, to fully implement. And that may be too late.

"I simply don't think that involuntary commitments are going to be an effective tool toward stemming mass shootings," says Jeff Deeney, a social worker in Philadelphia who writes about mental health for TheAtlantic.

Deeney says just a tiny fraction of mentally unstable people are a threat to public safety.

"I think what we don't have that people want so desperately is the program that stops nonviolent non-offenders from committing their first violent crime because of a mental illness," he says.

Deeney wants to see the conversation shift away from involuntary treatment programs like Laura's Law and toward preventive measures at high schools and college campuses.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

DAVID GREENE, HOST:

Many are wondering if a deadly rampage in Santa Barbara last weekend could have been prevented since the young shooter Elliot Rodger was showing signs of mental health problems. It's a difficult question that's come up after other mass shootings. Like many states, California has a law to mandate mental health care for people who've been refusing it, but as NPR's Kirk Siegler reports, local officials have been slow to adopt it.

KIRK SIEGLER, BYLINE: The story behind Laura's Law, as it's known here, begins in 2001. In rural Nevada County, near Lake Tahoe, 19-year-old Laura Wilcox was shot and killed by a 41-year-old man with a history of mental illness. Tom Anderson was the county's chief public defender at the time and represented the gunman in court. He recalls that the man's family had tried to alert mental health officials numerous times before the shooting.

TOM ANDERSON: You know, they were declaiming privacy issues and stuff and wouldn't communicate with the family. He was - started amassing guns and setting up booby traps around his house and he had this psychosis of he was going to be attacked any minute.

SIEGLER: Anderson is now Nevada County's presiding judge, he's also a vocal advocate for Laura's Law. It was passed by the state legislature in 2002. It allows counties to compel outpatient treatment for people whose family or other acquaintances are concerned about their mental state. It's seen as an intermediate step before someone is forced into inpatient psychiatric care.

Anderson says it could be one tool to prevent future violent incidents, including mass shootings. And the patients, they often respond positively.

ANDERSON: The beauty of the program - the wonderment of it to me - is that roughly about 60 percent of the people that they do outreach to, where they go out to intervene after the person's been referred, voluntarily accepts services at that time.

SIEGLER: But implementation of Laura's Law is left to the counties, and so far only two, Nevada County and Orange County, have gone forward. The state hasn't allocated any specific funding to it. And its controversial - the mental health community is divided. There are concerns that involuntary treatment could make mentally ill people vulnerable to civil rights abuses.

STEVE PITMAN: You do have to be conscious that even though these people are mentally ill, they do have rights.

SIEGLER: Steve Pitman is the president of the Orange County chapter of the National Alliance on Mental Illness. Pitman, whose brother battled mental illness for 50 years, says family members need more power to intervene and force treatment. He says they're the ones who often know what's really going on, while police or a county mental health official may only have just a few minutes to drop by for a welfare check.

PITMAN: The problem in so many of these cases is that when they're interviewed to see if they meet those kind of threshold requirements, they don't give off any signals of being a danger to themselves or others. And somebody who's experienced in these kinds of things knows all the right answers to give. They don't want to go to the hospital, and so they say all the right things.

SIEGLER: That scenario echoes Elliot Rodger's alleged behavior prior to the Santa Barbara incident. But experts, Pitman included, are cautious about linking reforms like Laura's Law too closely to recent mass shootings. For one thing, they say, intervention cases that fall under Laura's Law may take weeks, if not months, to fully implement. And that may be too late.

JEFF DEENEY: I simply don't think that involuntary commitments are going to be an effective tool for stemming mass shootings.

SIEGLER: Jeff Deeney is a social worker in Philadelphia who also writes about mental health for The Atlantic monthly.

He says just a tiny fraction of mentally unstable people are a threat to public safety.

DEENEY: I think what we don't have that people want so desperately is the program that stops nonviolent non-offenders from committing their first violent crime because of a mental illness.

SIEGLER: Deeney wants to see the conversation shift away from involuntary treatment programs and toward preventative measures that are starting to happen at high schools and college campuses. Kirk Siegler, NPR News.